Rickets

Rickets is a bone disease that affects infants and young children. A child’s growing bones fail to develop properly, usually because of a lack of vitamin D, calcium or phosphorus. This can lead to soft, weakened bones, fractures, bone and muscle pain, and bony deformities.

You can help protect your child by understanding the risk factors for vitamin D deficiency and taking steps to prevent it. Although it remains uncommon, rickets appears to be becoming more common in some places, and most cases are linked to low levels of vitamin D. One possible reason for rising rates is the heavy use of sun protection, driven by greater awareness of the risks of sun exposure.

If you think your child has rickets or may be at risk of vitamin D deficiency, talk to your doctor or another health care provider. They can help you decide on an appropriate treatment plan.

Signs and symptoms#

Signs and symptoms of rickets can include:

• painful bones, muscle weakness, cramps and spasms
• slowed growth and development
• an increased risk of broken bones, including fractures that happen without obvious pressure or injury
• skeletal deformities such as bowed legs, kyphosis (“hunch-back”), scoliosis (sideways curves of the spine), an outward-jutting breastbone or an abnormal skull shape
• dental problems, such as teeth failing to form or being slow to emerge, deformed teeth or soft tooth enamel
• a prominent forehead and a large front fontanelle (soft spot) in infants

Who is at risk#

Rickets is more likely in children who get little sunlight or whose diet is low in vitamin D and calcium. Some populations are affected more than others. A child may be at increased risk if they:

• have naturally very dark skin, which tends to absorb less sunlight than lighter skin
• are born to a parent with vitamin D deficiency
• cover most of their body for religious or cultural reasons
• are unwell, have a disability or are unable to spend time outdoors for other reasons
• never go outside without sunscreen
• have a medical condition, such as certain bowel diseases or disorders of the intestine, liver or kidneys, that prevents the body from absorbing vitamin D or converting it into its active form
• have a disorder that reduces the digestion or absorption of fats, as vitamin D is fat-soluble
• have low levels of vitamin D or calcium in their diet

The role of vitamin D#

The body needs vitamin D to absorb calcium and phosphorus. These minerals are essential for the growth and development of strong, healthy bones. A lack of vitamin D reduces the body’s ability to control the levels of these minerals and increases a child’s risk of rickets.

About 90 per cent of our vitamin D comes from sunlight. When direct sunlight reaches the skin, ultraviolet (UV) radiation converts a substance in the skin called 7-dehydrocholesterol into vitamin D. There are also very small amounts of vitamin D in some foods, but food sources alone are usually not enough to maintain the levels the body needs.

Once vitamin D is made in the skin or absorbed from food through the intestine, the liver and kidneys change it into its active form, a hormone. It is then available to help build strong bones and teeth through a process called “mineralization”.

Sun exposure and protection#

UV radiation levels vary depending on location, time of year, time of day, cloud cover and the surrounding environment. Babies and young children are particularly vulnerable to UV damage and should always be well protected whenever UV levels reach 3 or above.

Physical sun protection measures, such as dense shade, cool covering clothing and wide-brimmed hats, are recommended. For infants 6 months and older, apply a sensitive sunscreen to the small areas of exposed skin not covered by clothing or hats.

Preventing rickets#

Rickets can often be prevented by preventing or treating low vitamin D levels, alongside a diet with enough calcium and phosphate.

Diagnosis#

Rickets may be diagnosed using a number of tests, including:

• a physical examination
• blood tests
• long bone x-rays
• bone scans

Treatment#

Treatment options for rickets include:

• improved sunlight exposure
• an improved diet that includes enough calcium and vitamin D
• oral vitamin D supplements, which may need to be taken for around 3 months
• special forms of vitamin D supplements for people whose bodies cannot convert vitamin D into its active form
• surgery to correct severe bone deformities
• treatment for any underlying disorder

Poorly mineralized bones generally respond very quickly to dietary calcium and vitamin D, and improvements may be seen on x-ray after only a few days of treatment. If rickets is treated while the child is young, there is a good chance that the skeletal deformities will resolve as the child grows. However, if a child goes through puberty without treatment, the deformities and reduced height may be permanent.

Key points#

• Rickets causes soft, weakened bones in infants and young children, and is usually due to a lack of vitamin D, calcium or phosphorus.
• Overuse of sun protection may be one reason for rising rates in some places.
• Most of our vitamin D comes from sunlight, but children still need protection from UV damage.
• Talk to a health care provider about an appropriate treatment plan, which often includes diet, vitamin D supplements and managing any underlying condition.

Where to get help#